News Commentary: Antipsychotic Drug Prescriptions for Children

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Diagnosis-Driven Treatment
Profits Big Pharma,
Not Children

Within days of an article in The New York Times Magazine with a title posing the question Can Preschoolers Be Depressed? a special report appeared in the same newspaper (Child’s Ordeal Shows Risks of Psychosis Drugs for Young) about the use of off-label, heavy-duty antipsychotic medications for the same age group.  Not unlike big tobacco’s attempts to expand its market base by appealing to young consumers with cartoon characters like Joe Camel, the pharmaceutical industry sends representatives to the offices of pediatricians and child psychiatrists to leave behind promotional items like Legos emblazoned with the logo for Risperdal, one such drug.

Insufficient research to support prescribing these drugs for small children has not prevented the practice, which finds ready takers among low-income families without the resources to understand or access other options like parenting instruction and family and individual therapy.  At their wit’s ends, mothers of so-called difficult children follow the advice of their doctors to give their two-year-olds drugs with serious side effects like weight gain and diabetes.

In the piece questioning the existence of diagnosable depression in young children as early as infancy, naysayers insist it’s inadvisable to label symptoms like anhedonia (inability to feel pleasure), low energy, poor appetite, insomnia, poor self-esteem and pervasive negativity as an emotional disorder.  Variability of expression and the immaturity of the brain, the say, renders it premature to label small children in that way.

Those who support the diagnosis point to scans showing similar changes in the hippocampus and certain neural networks in the brains of depressed children and adults.  Other studies link depressive symptoms in children with family problems;  e.g., a mother’s depression can quickly impose itself on her baby by virtue of her own joylessness and lack of responsiveness.  In addition, children are ill equipped to handle emotionally and physically overwhelming experiences like abuse and neglect, death and/or separation from caregivers, and any of the many other calamities that can befall them.  When children act out their distress in developmentally appropriate ways, they too often become a problem to be fixed, rather than being seen as the canary in the coal mine heralding impending doom.

To recognize the reality of depression in young children, one need only listen to adults whose early lives were rife with difficulties.  Traumatic experiences like incest and other forms of abuse have devastating effects on the still-forming brain.  Living in circumstances where caregivers struggle with their own pain- and anxiety-filled existence weighs heavily on the spirits of children.  As quiet as it’s kept, four-year-olds have been known to deliberately swallow bleach and six-year-olds to throw themselves down a flight of stairs with their arms at their sides, all in hopes of escaping what for them has become a prison of pain.

Yet to establish a diagnosis of depression in children provides a rational for medicating them with the same antipsychotic drugs being used for acting out behaviors like aggression, self-injury, tantrums and severe mood swings.  Any of these symptoms,  signs of distress in a child, requires attention to the entire environment, including parents, siblings and others involved in the child’s life.  Helping the caregivers invariably helps the children.  Drugging children solves nothing and interferes with normal brain development, only one of many side effects.

Both cited articles mention successes with early interventions that take advantage of the plasticity of the young brain.  Certainly, ensuring a safe environment for the child takes precedence.  In yet one more report of severe neglect resulting in the death of a preschooler, the family was not unknown to child protective services.  Evidence suggests that the four-year-old girl with congenital health problems who weighed all of  15 pounds had been physically restrained with twine.  Perhaps she had become too much for an overwhelmed mother to handle, not unlike the children of some of the mothers who desperately seek help from their doctors and receive only psychotropic prescriptions for their children.

The way to assist frustrated parents lies not in the direction of prescribing narcotizing drugs to those among their children who broadcast otherwise silent family problems.  The best approach requires a commitment of time and resources to uncover and address the specific environmental challenges interfering with the child’s healthy development.